Statistics show that the presence of type 2 diabetes is a complete surprise for 50% of people. The diagnosis is made either by chance during examination of a person, or as a concomitant of the current disease. The result of this attitude towards one's health is complications typical of diabetes. Even occasional excesses of the normal limit of blood sugar levels (above 5.5 mmol/l) already indicate disruptions in the system of glucose absorption by the body. The reasons lie either in the dysfunction of the pancreas, which produces insulin, or in the inability of cells to absorb the glucose product offered to it after processing it with insulin. Low biological activity of the hormone is caused by pathological changes in the working cells of the gland that produce it.

Such destruction of b-cells can be the result of disorders of intrauterine development, postnatal nutrition and genetic failures. Hyperglycemia arising for various reasons with a sugar level of more than 6.7 mmol/l raises a well-founded assumption of the presence of diabetes mellitus. This type 2 disease can develop at any age, but it is most common in people over 40 years of age. The disease progresses slowly and is not accompanied by significant symptoms for a long time. Most often, an “experienced” patient is overweight, but in modern society This phenomenon is not uncommon for other reasons. When a diagnosis of type 2 diabetes is made, it is necessary to urgently begin treatment under the supervision of an endocrinologist.

Basic nutrition for diabetics

Diet for type 2 diabetes is the main therapeutic factor. The basis for successful treatment is the patient’s careful compliance with all the doctor’s instructions. Unauthorized changes in the nature of the prescribed diet or irregular intake of medications can cause serious consequences. Diabetes mellitus involves:

• exclusion of sweets that immediately supply glucose into the blood: sweets and honey, sugar and jam, cakes and baked goods;
• limiting the consumption of foods high in carbohydrates: bread, flour and cereal products, potatoes;
• carrying out fasting days, for example, apple, kefir, cottage cheese-kefir days.

However, these restrictions do not imply a harsh way of eating, devoid of a rich palette of taste sensations. On the contrary, a mild to moderate form of type 2 diabetes with systematic control of sugar levels makes it possible to include not a large number of sweets. Diet for type 2 diabetes allows for the consumption of many different and delicious dishes. Even a healthy person can adhere to it fully and with great pleasure. Doctors and culinary specialists unanimously claim that diabetes requires respect and will not allow a person to continue to ruin his body uncontrollably.

Vegetables and fruits should become the basis of the diet of diabetics, and the main criterion for the amount of food intake is the rule: everything is healthy that is consumed within reasonable limits. Experts recommend using the principle of fractional nutrition, that is, the daily amount of food should be eaten in equal portions in 4-6 meals. The choice of foods for type 2 diabetes should be made in favor of those rich in micro- and macroelements and vitamins. Using natural and varied food, you will not feel the strong pressure of the ban. But remember that diet is one of the methods of therapy and should be prescribed by a doctor, taking into account your medical history, test results and the state of the body at the moment.

For diabetes, a standard daily food distribution is established:

• vegetables - up to 900 g;
• fruits - up to 400 g;
• fermented milk products - up to 0.5 l;
• meat and fish - up to 300 g;
• mushrooms - up to 150 g;
• carbohydrates - 100 g of bread (can be replaced with 200 g of potatoes or cereals).

When choosing recipes for yourself for type 2 diabetes, you should remember that a dish that includes proteins and complex carbohydrates may contain only a small amount of healthy fats: vegetable oils or nuts. Nutritionists recommend that people with this diagnosis eat at the same time every day, and be sure to have dinner no later than 2 hours before bedtime. They also warn about the inadmissibility of skipping breakfast, since morning food is the best way to stabilize blood sugar levels. Diabetics should adhere to this type of diet throughout their lives. This will keep them physically fit and protect them from serious complications from the cardiovascular system.

Using innovative techniques for losing weight

When there is a metabolic disorder, cells need a sufficient amount of vitamins and microelements to function properly, so berries and fruits for type 2 diabetes play an important role in the diet of patients. You just need to know when to stop and not get carried away with such sweet fruits as grapes and raisins, bananas and dates. It is important to eat slowly and consciously because the brain needs time to feel full. There is no need to eat a bad mood with “sweets”; there are other ways to inspire: music, walks, massage. They will certainly help reduce the amount of calories entering the body, as well as glucose and other tricks:

• replace the bun in the minced meat cutlets with oatmeal or zucchini;
• replace polished rice with unprocessed rice;
• give preference to casseroles and vegetable pates;
• Use stewed vegetables as a side dish.

Medicines that affect the metabolic rate in the body will help remove fat deposits characteristic of this disease. It has been found that ginger for type 2 diabetes can effectively remove toxins from cells and water from the intercellular space. Adding it to food, even in the form of a dry powder, significantly improves digestion, accelerates intestinal motility and the general condition of the body as a whole. Drinks with ginger are quite effective and pleasant. Lowering blood pressure and improving the functioning of the heart muscle are the predicted results of consuming this spice. But you need to know that simultaneous use of ginger with sugar-lowering drugs can enhance their effect, so consultation with your doctor before using ginger supplements is mandatory.

Combining it with another spice - cinnamon, you can give an even more noticeable boost to speed up metabolic processes. Cinnamon for type 2 diabetes can help cells “accept” the offered glucose and limit, to a certain extent, the growth of cholesterol in the body. Here is a recipe for those who want to not only remove extra pounds, but also increase the acuity of their brain’s perception of the world around them:

• powdered mixture of cinnamon and ginger - ½ teaspoon;
• red pepper – 1 g;
• kefir – 250 ml.

It is important to remember that there are enough contraindications for taking cinnamon. The presence of hypertension, allergic reactions and a tendency to bleeding in patients is a “stop” signal for its use. During pregnancy, cinnamon should also be avoided. The benefits of fasting for type 2 diabetes have not been clearly assessed to date, but fasting days are welcomed by both nutritionists and endocrinologists. Each patient approaches the choice of its type individually, in accordance with his preferences.

Given the role of hereditary predisposition in the occurrence of the disease, members of families where there are already diabetic patients should follow a diet with some restriction of carbohydrates in the diet. For preventive purposes, older people, primarily those suffering from obesity, atherosclerosis and hypertension, should undergo regular examinations for sugar levels in the blood and urine. For diabetics, rational employment and an active lifestyle play an important role in maintaining physical fitness and good sugar levels. They are contraindicated in hard work, lack of the necessary rhythm of daily food intake and strong emotional stress.

Diabetes mellitus does not have clearly defined degrees that can be expressed by numerical indices. Usually there are mild, moderate and severe degrees of the disease. But there are two types of this disease - the first type (insulin dependent) and the second type (non-insulin dependent).

It is especially important for such patients to adhere to the rules of rational nutrition, since in this case it is the correction of the diet that is the main method of treatment.

Why diet?

In type 2 diabetes, tissue sensitivity to insulin is impaired and insulin resistance occurs. Despite the sufficient production of this hormone, glucose cannot be absorbed and enter the cells in the required quantity, which leads to an increase in its level in the blood. As a result of this, the patient develops complications of the disease that affect nerve fibers, blood vessels, tissues of the lower extremities, retina, etc.

Most patients with type 2 diabetes are overweight or even obese. Due to their slow metabolism, the process of losing weight does not proceed as quickly in them as in healthy people, but they absolutely need to lose weight. Normalizing body weight is one of the conditions for good health and maintaining blood sugar at the target level.

What to eat when diabetes mellitus to normalize tissue sensitivity to insulin and lower blood sugar levels? The patient's daily menu should be low in calories and contain mainly slow rather than fast carbohydrates. Doctors usually recommend sticking to diet No. 9. At the stage of losing weight, the amount of fat in dishes should be reduced (it is better to give preference to fats of vegetable origin). It is important for diabetics to get enough protein, as it is building material and promotes the gradual replacement of adipose tissue with muscle fibers.

A balanced diet can improve tissue sensitivity to insulin and normalize the processes of regulating blood sugar levels.

The main goals of the diet for type 2 diabetes are:

• weight loss and reduction in body fat;
• normalization of blood glucose levels;
• maintaining blood pressure within acceptable limits;
• lowering blood cholesterol levels;
• prevention of severe complications of the disease.

A diet for type 2 diabetes is not a temporary measure, but a system that must be followed constantly. This is the only way to keep blood sugar at a normal level and maintain good health for a long time. In most cases, just switching to proper nutrition enough to keep diabetes under control. But even if the doctor recommends that the patient take glucose-lowering pills, this in no case cancels the diet. Without nutritional control, no medication will bring a lasting effect (even insulin injections).

Healthy natural foods help maintain normal blood sugar levels and control blood pressure

Cooking methods

With type 2 diabetes, it is advisable for patients to prepare food in gentle ways. The optimal types of cooking are considered to be such culinary processes as steaming, boiling and baking. Diabetics can eat fried foods only occasionally, and it is preferable to cook them in a small amount of vegetable oil, or even better, in a non-stick grill pan. With these cooking methods, the maximum amount vitamins and nutrients. When prepared, such dishes do not burden the pancreas and other organs of the digestive tract.

You can also stew dishes in your own juice, choosing only low-calorie and low-fat foods. It is not advisable to add store-bought sauces, marinades and large amounts of salt to your food. To improve the taste, it is better to use permitted seasonings: herbs, lemon juice, garlic, pepper and dried aromatic herbs.

Meat

Meat is a very important source of protein for diabetes because it contains essential amino acids that the human body cannot produce on its own. But when choosing it, you need to know certain rules so as not to accidentally harm your health. Firstly, the meat must be dietary. For sick people, the best types of this product are chicken, turkey, rabbit and lean veal. Secondly, it must be perfectly fresh; it must not contain a large number of veins and muscle films, since they take a long time to digest and can create a feeling of heaviness, slowing down the intestines.

The amount of meat in the diet should be limited, but the daily dose should provide a person with a sufficient amount of protein. The distribution of proteins, fats and carbohydrates is selected individually for each patient by the attending physician. It depends on many factors - weight, body mass index, age, anatomical features and the presence of concomitant diseases. The correct ratio of calories and nutrients ensures the body is properly supplied with energy, vitamins and minerals.

Prohibited types of meat for diabetes:

• goose;
• duck;
• pork;
• mutton;
• fatty beef.

Patients should not eat lard, smoked meats, sausages and rich meat broths. It is allowed to prepare soups with poultry meat, but the water must be changed after the first boil. You should not cook soup with bone broth, as it is difficult to digest and puts extra stress on the pancreas and liver. During cooking, you should always remove the skin from poultry so that it does not get into the dish. excess fat. It is always better to give preference to fillet and white meat, which has a minimal amount of connective tissue and fatty streaks.

It is advisable to replace animal fats with vegetable fats as much as possible. Olive, corn and flaxseed oils are considered the most beneficial for people with diabetes.

Fish

Fish must be present in the diet of a diabetic patient at least once a week. It is a source of healthy proteins, fats and amino acids. Eating fish products helps improve the condition of bones and muscles, and also helps prevent cardiovascular diseases. The healthiest fish allowed, according to the diet rules, for diabetics is low-fat fish that is cooked in the oven or steamed.

Diabetics can eat tilapia, hake, pollock, tuna, and cod. It is also advisable to periodically include red fish (trout, salmon, salmon) in your diet, as they are rich in omega acids. These biologically active substances protect the body from the development of cardiovascular diseases and help reduce the level of “bad” cholesterol.

Patients should not eat smoked and salted fish, because it can cause problems with the pancreas, as well as provoke the appearance of edema and the development of hypertension. Since type 2 diabetes mellitus usually develops in middle-aged and elderly people, the problem of high blood pressure is relevant for many of them. Eating very salty foods (including red fish) can cause pressure surges and worsen the condition of the heart and blood vessels.

When cooking fish, it is better to add a minimum amount of salt to it, replacing it with other spices and seasonings. It is advisable to bake it without adding oil, since this product itself already contains a certain amount of healthy fats. To prevent the fillet from being dry, it can be cooked in the oven in a special plastic sleeve. Fish cooked this way contains more moisture and has a melty texture.

Diabetics are prohibited from using white fish fatty varieties (for example, pangasius, notothenia, herring, catfish and mackerel). Despite their pleasant taste, these products, unfortunately, can cause extra pounds and cause problems with the pancreas. Lean fish and seafood are a healthy natural source of vitamins and microelements that are perfectly absorbed by the body.

It is beneficial for diabetics to eat boiled seafood. Shrimp, squid and octopus contain large amounts of protein, vitamins and phosphorus

The diet for type 2 diabetes is based on the predominance of plant foods in the diet, so vegetables in any form should be an important component of the food that patients eat. They contain very little sugar, and at the same time they are rich in fiber, vitamins and other valuable chemical elements. The healthiest vegetables for diabetes are green and red. This is due to the fact that they contain a large amount of antioxidants, which prevent the formation of harmful free radicals. Eating tomatoes, cucumbers, sweet peppers and green onions can increase human immunity and improve digestion processes.

The following vegetables are also beneficial for patients:

• cauliflower;
• Jerusalem artichoke;
• pumpkin;
• onions and blue onions;
• broccoli;
• radish;
• zucchini and eggplant.

Beets are also very useful for diabetics, as they contain amino acids, enzymes and slow carbohydrates. This vegetable contains no fat at all, so its calorie content is low. Beetroot dishes have anti-inflammatory and antiseptic properties, increase immunity and strengthen the walls of blood vessels. Another important property of beets for diabetics is the smooth regulation of intestinal motility, which helps avoid constipation and a feeling of heaviness in the stomach.

A rational nutrition system for type 2 diabetes allows you to include even potatoes in the diet, but this vegetable should not be fundamental when choosing and preparing dishes. It contains a lot of starch and has a relatively high calorie content (compared to other vegetables), so its quantity should be strictly limited.

In order for vegetables to bring only benefits to the body, they need to be cooked correctly. If vegetables can be eaten raw, and a diabetic does not have digestive problems, it is better to eat them in this form, since this preserves the maximum amount of useful elements, vitamins and minerals. But if the patient has concomitant problems with the gastrointestinal tract (for example, inflammatory diseases), then all vegetables must be subjected to preliminary heat treatment.

It is extremely undesirable to fry vegetables or stew them with large amounts of butter and vegetable oil, as they absorb fat, and the benefits of such a dish will be much less than the harm. Fatty and fried foods not only disrupt the functional activity of the pancreas, but also often cause weight gain.

Vegetables cooked with excess oil are high in calories and can raise blood cholesterol levels.

Fruits

Some patients, after being diagnosed with type 2 diabetes, try to exclude all fruits from their diet, leaving only sour, green apples and sometimes pears. But this is not necessary, since most fruits have a low glycemic index and contain small amounts of carbohydrates and calories. All fruits and berries with a low and medium glycemic index are beneficial for diabetics, because they contain a lot of vitamins, organic acids, pigments and mineral compounds.

Patients can eat the following fruits and berries:

• apples;
• pears;
• tangerines;
• oranges;
• grapefruits;
• apricots;
• plums;
• currants;
• cherry;
• cranberries;
• raspberries

Forbidden fruits for type 2 diabetes are melon, watermelon and figs because they have a high glycemic index and contain a lot of sugar. For the same reason, it is undesirable for patients to consume dried fruits such as dates and dried figs.

Peaches and bananas can be present in a diabetic's diet, but it is advisable to eat them no more than once or twice a week. For daily consumption, it is better to give preference to plums, apples and citrus fruits, because they help improve digestion and contain a lot of coarse fiber. They contain a lot of vitamins and minerals that are necessary for the coordinated, full-fledged functioning of the whole body.

Fruits are a healthy and tasty treat that can be used to overcome cravings for forbidden sweet foods. Patients who regularly eat fruit find it easier to stick to their diet and daily regimen.

Cereals and pasta

What can sick people eat from cereals and pasta? This list contains a lot of permitted products from which you can prepare delicious and healthy dishes. It is porridge and pasta that should be a source of slow carbohydrates, which the patient needs for brain function and energy. Doctor-recommended products include:

• buckwheat;
• oats that require cooking (not flakes) instant cooking);
• bulgur;
• peas;
• durum wheat pasta;
• Wheat groats;
• unpolished rice;
• millet.

It is extremely undesirable for diabetics to eat White rice, semolina and instant oatmeal. These products are high in carbohydrates, calories and low in biologically valuable substances. By and large, these cereals simply saturate the body and satisfy the feeling of hunger. Excessive consumption of such cereals can lead to weight gain excess weight and the appearance of problems with the digestive system.

But even permitted cereals need to be cooked and eaten correctly. It is best to cook porridge in water without adding oils and fats. It is preferable to eat them for breakfast, since carbohydrates should provide the patient with energy for the whole day. You should always remember these simple recommendations, since correctly selected and prepared cereals will only bring benefits and will not harm human health.

If you have type 2 diabetes, you need to eat smaller meals. It is advisable to divide your daily diet into 5-6 meals.

What should you give up?

Patients with type 2 diabetes should completely exclude the following dishes and foods from their diet:

• sugar and products containing it;
• fatty dishes prepared using large amounts of vegetable or butter;
• smoked meats;
• semi-finished products and fast food;
• marinades;
• salty and spicy hard cheeses;
• bakery products made from premium flour.

You cannot make exceptions to the rules and occasionally use something from the prohibited list. With type 2 diabetes, the patient does not receive insulin injections, and the only chance to keep blood sugar at a normal level is to eat right, while following other recommendations of the attending physician.

Sample menu for the day

It is better to create a menu for the day in advance, calculating its calorie content and the ratio of fats, proteins and carbohydrates in dishes. Table 1 shows the calorie content and chemical composition of some products that are allowed in diet No. 9. Guided by these data, the recommendations of your doctor and the composition, which is always indicated on the packaging of products, you can easily create a diet with optimal energy value.

Table 1.

A sample menu for the day might look like this:

• breakfast - oatmeal, a slice of low-fat cheese, whole grain bread without yeast;
• snack – nuts or apple;
• lunch – vegetable broth, boiled chicken breast or turkey, buckwheat porridge, berry juice;
• afternoon snack - allowed fruit and a glass of rosehip decoction;
• dinner – steamed fish with vegetables or low-fat cottage cheese, a glass of compote without sugar;
• snack before bed – 200 ml of low-fat kefir.

The diet of a person with type 2 diabetes can be truly varied and tasty. The lack of sweet foods in it is compensated by healthy fruits and nuts, and fatty meat is replaced with dietary options. The big advantage of this menu is that it can be prepared for the whole family. Restriction in animal fats and sugar is beneficial even for healthy people, and in case of diabetes, this is a prerequisite for maintaining normal well-being for many years.

Do you have type 2 diabetes or are you at increased risk of developing it? Are you worried about your blood glucose levels? Or are you caring for someone with diabetes? Then you've come to the right place. In this article, we will share with you information on how to improve blood glucose control through diet therapy.

Many people with diabetes or pre-existing carbohydrate metabolism disorders (called prediabetes) have improved their health through dietary changes. This opportunity exists for you too. Thanks to changes in diet, it becomes possible for some people to reduce the amount of glucose-lowering medications they take.

​What is diabetes?

Diabetes mellitus is an increase in the level of “sugar” (glucose) in the blood. The cause of high blood glucose levels depends on the type of diabetes. However, with all types of diabetes there are disturbances in the production and use of insulin in the human body.

In type 2 diabetes, the body initially produces insulin normally, but is unable to use it effectively, this is called insulin resistance. This then makes it more difficult for the body to manage blood glucose levels. And it turns out that glucose is in excess quantities in the vascular bed, but does not reach the organs. Excess glucose in the blood is harmful due to its damaging effect on blood vessels. At the same time, internal organs find themselves in “starvation” mode, because glucose remains in the bloodstream and does not enter the organ cells. Because of this, diabetes mellitus is poetically called “hunger among plenty.”

The hormone insulin, produced by the pancreas, controls the level of glucose in the blood and removes it from the bloodstream into the cells. internal organs. The more glucose in the blood, the more insulin the pancreas produces in response. Elevated glucose levels lead to temporary excess insulin in the blood - hyperinsulinemia. Excess insulin increases the accumulation of fatty acids in the body and slows down their breakdown, preventing the body from using fats as energy fuel.

All these pathological reactions are formed in most cases against the background of an increase in body weight and the amount of visceral fat (assessed by waist circumference). Diet can improve cell sensitivity to insulin, reduce body weight, and this, in turn, improve diabetes control.

​​​Nutrition​and sugartype 2 diabetes

People with diabetes have difficulty maintaining blood glucose levels within normal limits. Glucose enters our blood from two sources: from reserves in the liver and from the food we eat. We cannot control the amount of glucose the liver produces, but we can control the food we eat.

Carbohydrates

Carbohydrate foods, when digested, form large amounts of glucose. The more carbohydrates eaten, the more glucose enters the blood.

Carbohydrates are simple, quickly digestible, which are quickly absorbed during the digestion process, enter the bloodstream and significantly increase blood glucose. These are various sweets: containing sugar, fructose, glucose. But complex, slowly digestible carbohydrates can significantly increase blood glucose if their glycemic index is high.

The glycemic index (GI) is a measure of how quickly a food raises blood glucose levels compared to how much pure glucose does. The higher the glycemic index of a product, the more it increases blood glucose. So, some foods that we consider “healthy”, such as fruit, can actually significantly increase your glucose levels. Also, “starchy” foods - such as baked goods, cereals, pasta and potatoes - turn into glucose after consumption. Potatoes can raise your blood glucose levels to the same extent as nine teaspoons of sugar.

​Fiber

Dietary fiber (fiber) is found in fruits, vegetables, whole grains and legumes. It is recommended to consume at least 25 g of fiber per day. Moreover, a greater amount of it significantly reduces the risk of cardiovascular diseases, obesity and type 2 diabetes. However, some foods contain fiber along with carbohydrates (for example, fructose in fruits), and this food will increase blood glucose levels. And in some foods (most vegetables), the fiber content is high and carbohydrates are minimal, and they will not affect blood glucose.

Squirrels

Protein foods include eggs, meat and fish. Although different people react differently to some protein products, consuming moderate amounts of protein (less than 30 grams of pure protein) generally has little effect on blood glucose levels.

Fats

We rarely consume fats in their pure form (except in vegetable oils). We mainly eat them in one product with proteins (cheese, sour cream), with carbohydrates and proteins (other dairy products) or with carbohydrates (sweets, baked goods, fast food). When combined with proteins, fats have little effect on glucose levels. When combined with carbohydrates, they can significantly increase blood glucose levels.

​How to reduce blood glucose levels?

There are medications that can help lower blood glucose levels. And in a number of situations it is impossible to do without them. But the basis of any treatment for type 2 diabetes is changes in lifestyle, in particular in diet. Sometimes you can get by with just them, sometimes you can’t, but they are still important. What happens if you remove foods that greatly increase your blood glucose levels from your diet? Will there be anything tasty left? Yes. These are just a few of the delicious foods that won't raise your blood glucose levels:

Currently, as part of dietary therapy for type 2 diabetes, there is a low-carbohydrate diet (). Against this background, blood glucose control improves, its variability (fluctuations) decreases, the need for drug therapy may decrease, well-being improves, and the level of energy and mental activity increases. Because of these benefits, the low-carb keto diet can be recommended for people with type 2 diabetes, and many doctors recommend it to their patients. Choosing low-carb foods is an easy way to reduce blood glucose levels. If you are considering this treatment option, you should consult with your healthcare provider to adjust your medication dosage as you change your diet to avoid possible low glucose levels (hypoglycemia), and to discuss whether you have any restrictions or contraindications to this diet.

​What does science say now about diabetes treatment?

In 2019, the American Diabetes Association (ADA) released new guidelines for managing type 2 diabetes. They indicate that low-carbohydrate diets may improve blood glucose control and reduce the use of glucose-lowering medications in people with type 2 diabetes. Evidence includes meta-analyses of randomized controlled trials (most high level evidence).

Scientific research:

Diabetes Research and Clinical Practice 2018: Effects of dietary carbohydrate restriction on glycemic control in adults with diabetes: a systematic review and meta-analysis

​

BMJ Open Diabetes Research and Treatment 2017: Systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes [convincing evidence]

​

Diabetes, Obesity and Metabolism 2019: An evidence-based approach to developing low-carbohydrate diets for type 2 diabetes: a systematic review of interventions and methods [convincing evidence]

A 2017 meta-analysis found that low-carb keto diets reduce the need for glucose-lowering medications and also improve health outcomes in people with type 2 diabetes: lower levels of glycated hemoglobin (HbA1c, “average sugar over 3 months”), triglycerides and blood pressure, increase the level of “good” cholesterol – high-density lipoproteins (HDL).

These new studies suggest that a low-carbohydrate keto diet is a possible way to improve blood glucose control and possibly prevent later complications of diabetes.

Scientific research:

European Journal of Clinical Nutrition 2017: Interpretation and impact of low carbohydrate diets in the treatment of type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials [convincing evidence]

​

Diabetes Therapy 2018: Efficacy and safety of a new type 2 diabetes treatment model at 1 year: an open-label, non-randomized, controlled trial

​

Frontiers in Endocrinology 2019: Long-term effects of a new continuous tele-assisted intervention including dietary ketosis for the treatment of type 2 diabetes: a 2-year non-randomized clinical trial

​Limitations and contraindications for a low-carbohydrate diet

• women who are pregnant or breastfeeding,
• people suffering from or at risk of eating disorders (anorexia, bulimia, compulsive overeating),
• people with kidney failure.

Use with caution in patients taking antidiabetic drugs such as sodium glucose cotransporter 2 (SGLT2) inhibitors due to the potential risk of ketoacidosis.

In type 1 diabetes, a low-carbohydrate diet does not allow one to refuse insulin therapy due to absolute insulin deficiency. In this disease, refusal of insulin leads to a life-threatening condition.

Because the Scientific research Since low-carbohydrate diets typically indicate problems with long-term nutritional sustainability, it is important to regularly review and individualize dietary recommendations for those interested in this approach.

​New hope

With increasing urbanization, stress, sedentary lifestyle and unharmonious diet, there is an “epidemic” of weight gain and type 2 diabetes.

Although diabetes is not a “curable” disease, it can be controlled. And proper nutrition is the basis for controlling your health, body weight and blood glucose.

Poor control of these indicators leads to the development of late complications of the disease - eye damage, kidney damage, poorly healing foot wounds and decreased cognitive function. Worst case scenarios include blindness, kidney failure and hemodialysis, amputation, dementia and death.

A low-carbohydrate diet may improve disease control and reduce blood glucose and body weight. Better disease control and reduced blood glucose variability (fluctuations) help prevent diabetes complications.

Discuss with your doctor how a low-carb keto diet might be a part of your treatment and health maintenance. If you are taking glucose-lowering medications, you should further discuss this with your endocrinologist. This is to ensure that your medications are adjusted safely as your blood glucose levels decrease to avoid hypoglycemia.

Type 2 diabetes mellitus is characterized by insulin resistance - impaired sensitivity of body cells to insulin. This endocrine (intrasecretory) hormone transports glucose into tissues and cells to provide them with the necessary energy. In the second type of disease, the pancreas does not stop producing insulin, but since the body is unable to consume it, unrealized sugar remains in the blood plasma. The main method of treating the disease is diet therapy. A properly formulated diet helps control glycemia and prevent the development of complications of the disease.

Dietetics and diabetes

Distinctive feature diabetes is polyphagia (permanent feeling of hunger). This is due to a deficiency of glucose as a source of nutrition and energy in the body's cells. Increased appetite provokes the development of obesity, which leads to heart pathologies and atherosclerosis (vascular damage by cholesterol growths). The diet for type 2 diabetes is aimed at normalizing glycemia and reducing body weight.

Medical classification Medical nutrition according to V. Pevzner provides for diabetics the “Table No. 9” diet. The menu is designed for weight loss, maintaining stable sugar levels, and restoring impaired metabolic processes. The main parameters of diet therapy for diabetes are: glycemic index (GI or GI) of foods, number of calories, balance of nutrients (fats, carbohydrates, proteins), diet and portion size.

According to Table No. 9, all products are divided into acceptable, prohibited and limited (allowed in limited quantities). By combining permitted and limited products, a daily diet is created. Nutrition should be complete, balanced, with strict adherence to dietary parameters.

Any food that enters the body affects blood sugar levels. GI is a value that indicates the rate of breakdown of food into its components, the release of glucose from it and its resorption (absorption) into the systemic bloodstream. Low GI foods are digested slowly and have little effect on glycemia. A high glycemic index of foods indicates their accelerated processing and immediate release of glucose into the blood. Such food for a diabetic is classified as prohibited.

Digital values GIs are distributed as follows:

• from 70 to 100 units – high index;
• from 30 to 70 – average;
• less than 30 – low.

There is a special table for the correct selection of products according to GI criteria. Prohibited foods for diabetics have a glycemic index above 70 units.

Calorie criterion

In order not to create additional stress on the weakened pancreas, a diabetic's food should not be heavy and difficult to digest. High-calorie foods, regardless of GI, require a lot of energy for processing, and a diabetic does not have a serious energy resource due to the poor supply of glucose to cells. In addition, excess calories do not contribute to weight loss. Daily caloric intake must be kept within 2200–2500 kcal. Percentage composition of nutrients:

• carbohydrates - 45%;
• proteins - 20%;
• fats - 35%.

Maintaining such a balance will allow metabolic processes to be as close to normal as possible.

Nutrients

Except percentage proteins, fats and carbohydrates, the diet provides for the differentiation of all categories of products into healthy and harmful.

Fats

The consumption of animal fats should be reduced as much as possible, since they accelerate the absorption of glucose and contribute to the deposition of “bad” cholesterol on the walls of blood vessels. As a result, sugar increases and atherosclerosis develops. You can regulate fat metabolism by replacing butter(lard) vegetable fats.

Squirrels

Essential amino acids, which the body cannot produce itself, it obtains from protein. The process of gluconeogenesis (the release of glucose from amino acids) occurs slowly, therefore, when people eat protein foods, the sugar level rises slightly and is not forced. The protein component of a diabetic diet should not be less than 20% of the total diet. Sources of protein for diabetics are dietary meats and fish, mushrooms, and some products of plant origin.

High protein foods that should be present in the diet of a patient with type 2 diabetes

Carbohydrates

The carbohydrate component is necessary for the body as the main energy source. This category of nutrients is divided into those that a diabetic can eat and those that must be avoided. Complex carbohydrates (polysaccharides) are processed slowly and do not cause a sharp rise in blood sugar. These include:

• glycogen (present in protein foods);
• pectin (found in vegetables, fruits and berries);
• fiber or cellulose (the main source is vegetables, herbs);
• starch (is a component of potatoes, pasta, legumes and grains).

Simple carbohydrates are: monosaccharides (glucose, fructose, galactose), disaccharides (sucrose, lactose, maltose). Foods high in simple carbohydrates are quickly absorbed, causing an immediate release of glucose into the bloodstream. In diabetes mellitus, this reaction of the body provokes glycemia, and can be life-threatening. Therefore, a low-carb diet for a diabetic means excluding fast carbohydrates from the diet and limiting complex ones.

Proper nutrition for type 2 diabetes prevents sugar spikes and helps restore cells' sensitivity to insulin. If you encounter difficulties when developing a menu, you should seek help from a nutritionist. The diet is developed taking into account the nature of the course and stage of the disease, age and individual characteristics of the patient’s body.

Postulates of therapeutic nutrition

When compiling a daily menu, a diabetic patient must consider not only what foods can be consumed, but also how to do it correctly. Medical nutrition must be organized according to the following rules:

• Eliminate disaccharides and monosaccharides from the diet. These components are contained in all possible types of sweets: confectionery, ice cream, candies, etc.
• Stick to the drinking regime. The amount of fluid consumed is from 1.5 to 2 liters per day.
• Maintain regular eating habits. You should eat every 3-4 hours.
• Don't be greedy with food. A single serving should not exceed 350–400 g of food. Overeating leads to excess weight gain.
• Control the number of calories and glycemic index of foods. Nutrition should be balanced, with strictly observed proportions of nutrients.
• Avoid dishes prepared by frying. Food needs to be prepared by boiling, stewing, or steaming. You can bake dishes in foil. This will help reduce caloric intake and relieve the pancreas.
• Introduce healthy vegetables and fruits from the list of permitted ones into your daily diet as a source of vitamins and minerals.
• Limit the amount of table salt in your diet and avoid salty foods (ideally switch to a salt-free diet). This measure will reduce the load on the kidneys and heart.
• Replace animal fats with vegetable fats (olive, corn, flaxseed and other oils).

What needs to be excluded

To avoid hyperglycemia, a diabetic needs to clearly know what not to eat. The bans primarily apply to sweet foods and drinks. Simple carbohydrates in their pure form are contraindicated for the patient. In addition, high-calorie fatty foods should be removed from the menu: fast food, smoked foods (meat, lard, fish), semi-finished products (dumplings, pasties, khinkali), sausages not specifically intended for diabetic nutrition, ham. It is prohibited to use flavored snacks and crackers, chips, or popcorn as a snack.

The following products are subject to removal from the food basket:

• Meat. Poultry (duck, goose), fatty pork.
• Fish. Preserves, dried product.
• Conservation. Meat pates, sprats, canned fish, pickled vegetables, sweet canned fruits in their own juice, compotes and jams.
• Cereals. Rice (white variety), sago, semolina.
• Dairy and fermented milk products with a high percentage of fat content. The permissible fat content is: cream and sour cream - 10%, cheese - 40-45%, yogurt - 3.2%, cottage cheese - 9%, fermented baked milk - 4%. Glazed cheese curds and sweet curds are prohibited.
• Floury. White bread, pasta of categories B, B, 1st and 2nd class, pastries made from butter, puff pastry, shortbread and choux pastry.
• Sauces and seasonings. Ketchups, mayonnaise-based sauces, mustard.
• Fruits. You should focus on the glycemic index. High GI: pineapple, figs, watermelon, grapes. From exotic fruits: papaya, carom, guava.

Table of foods not allowed for diabetes

Limited (limited for consumption) products

This category includes products with an average GI. For type 2 diabetes mellitus, their use is allowed in small quantities 1–3 times a week. If sugar levels are stable, this will not cause harm to health. Popular limited edition products:

• products made from unleavened dough: biscuits, pita bread, pita bread (without filling) and muesli – 67–69;
• potatoes (only boiled in their jackets is allowed), bananas, raisins – 64–66;
• fruits (mango, persimmon, kiwi) – 55, oranges – 44;
• unsweetened buckwheat porridge – 50;
• blueberries – 43;
• canned beans, corn, peas – 48–42;
• cheeses: feta, processed – 56–57.

A more detailed list of foods with an average glycemic index can be found on the website. Fatty fish (sturgeon, halibut, capelin, mackerel) are allowed to a limited extent as a source of omega-3.6 fatty acids. An endocrinologist will help you decide on foods that have an average GI. The doctor takes into account the nature of the disease and the individual characteristics of the patient.

Eligible Products

For a diabetic patient, a food package that will allow you to eat safely for health consists of protein and fiber. Allowed and recommended products for consumption are discussed below in the table.

Vegetables and greens must be included in the daily diet. These products are best consumed raw. Boiled carrots and beets have a high glycemic index and are not suitable for a diabetic menu. You can eat without restrictions:

Jerusalem artichoke and momordica (bitter gourd) are extremely useful for stabilizing sugar. Eating these vegetables activates endocrine and metabolic processes in the body and helps fight excess weight. The choice of fermented milk products is based on fat content, calorie content, and percentage of carbohydrates. If you have diabetes, you can eat and drink the following foods and drinks in this category: kefir - fat content up to 2.5%, Greek natural yogurt (without additives) - 2%, acidophilus - 3.2%, yogurt - 2.5%, sour cream - 10%, cottage cheese – 1.8–2%. Consumption of dairy products with fruit additives is undesirable, since they contain a fairly large amount of sugar.

Drinks for type 2 diabetes

IN dietary ration You should pay attention to your drinking regime and the drinks you consume. Most fruit juices have a medium glycemic index, so their consumption must be strictly controlled. Freshly squeezed undiluted juices are not recommended for consumption, as they have an aggressive effect on the pancreas. Other prohibited drinks include bottled tea and packaged juices (they contain a lot of sugar), 3-in-1 coffee and cocoa sticks, and cocktails with added syrup.

Important! Lemonades and any sweet soda are completely prohibited. In addition to their high sugar content, they have the ability to instantly penetrate the blood.

Alcohol is contraindicated for diabetes. Light alcoholic drinks, as a rule, have a high GI, while strong ones burden the diseased pancreas and cardiovascular system. Recommended drinks are mineral water (preferably still), homemade jelly and compotes brewed without sugar, decoctions of medicinal herbs and rose hips, tea (green, black, hibiscus, oolong). Drinking coffee in small quantities is not prohibited. Just don’t brew a strong drink and drink it with sugar.

Artificial sugar substitutes belong to a limited category. Allowed for type 2 diabetes nutritional supplements E950, E951 and E952 (Acesulfame potassium, Aspartame and Sodium Cyclamate), trichlorogalactosucrose (Sucralose), glycoside from the leaves of the stevia plant (Steviazid). Sorbitol and xylitol are high in calories, so it is better not to use them.

Sugar substitutes do not affect glycemic levels, but they should not be abused

Before starting to use sweeteners, you must obtain the approval of your treating endocrinologist. The substances have a number of contraindications.

Diabetic diet

The menu for the week is compiled by combining products from the permitted category. All dishes and drinks are prepared without added sugar. Morning meal: cottage cheese casserole, cooked in the microwave, protein omelet with feta cheese, milk porridge (oatmeal, wheat, barley). Drinks: black tea, red tea, oolong tea, coffee with milk. Lunch: fruits (from the allowed list), berry jelly, pita bread with processed cheese, diabetic cookies, biscuits, yogurt with added muesli. Drinks: freshly squeezed (diluted with water) apple and grapefruit juice, hibiscus tea

First courses for the day: frozen seafood soup, bean soup chicken broth(the skin of the chicken must be removed), cabbage soup in turkey (chicken) broth, mushroom soup, pollock soup, navaga, cod. Salads: fresh cucumbers, tomatoes, greens, fresh cabbage + carrots, seaweed + fresh cabbage + fresh cucumbers. You should make your own salad dressings using recipes that do not contain mayonnaise. Soy sauce is allowed in limited quantities due to the abundance of salt. 10% sour cream, Greek yogurt, vegetable oils, lemon juice are allowed.

Drinks: homemade fruit and berry compote or jelly. Side dishes for lunch and dinner: steamed vegetables, pearl barley or buckwheat porridge in water, potatoes boiled “in their jackets” (once a week), stewed cabbage. Afternoon snack: cheesecakes with berries, cooked in the oven, oatmeal jelly, fruit puree. Main courses for evening reception food: stewed vegetables with rabbit meat, steamed poultry (fish) cutlets or meatballs, boiled fish, cabbage rolls with chicken.

Drinks: green tea, herbal tea. To improve the functioning of the digestive system, 1.5 hours before bedtime, it is recommended to drink any fermented milk drink with low fat content (yogurt, kefir, fermented baked milk). Treatment of diabetes mellitus is impossible without correcting the patient's eating behavior. Poor nutrition leads to the fact that the pancreas stops producing endocrine hormones and diabetes becomes insulin-dependent.

According to statistics, many patients with type 2 diabetes are overweight, and they are also elderly people.

Only 8% of patients have normal body weight.

As a rule, a person is diagnosed with a combination of two or more risk factors for developing the disease.

Let's consider the factors that increase the risk of the onset of the disease:

1. Genetic predisposition. If one of the parents has T2DM, the probability of inheritance is 30%, and if both parents are sick, then the risk increases to 60%. Increased sensitivity to a substance that enhances insulin production, which is called enkephalin, is inherited.
2. Obesity, excess body weight, abuse of harmful products.
3. Traumatic damage to the pancreas.
4. Pancreatitis, causing damage to beta cells.
5. Frequent stress, depression.
6. Insufficient physical activity, predominance of adipose tissue over muscle.
7. Transferred viruses(chickenpox, mumps, rubella, hepatitis) - provoke the development of the disease in people with a hereditary predisposition.
8. Chronic diseases.
9. Old age (over 65 years old).
10. Hypertonic disease and increased concentration of triglycerides in the blood due to overuse of fatty foods.

Diagnostic methods

In persons who fall under one of the risk factors listed above, a set of laboratory tests is carried out to allow timely identification of the disease.
If you are at risk, you need to be tested once a year.

If suspected, the following tests are prescribed:

• determination of glucose concentration in capillary blood;
• glucose tolerance - a test for early detection of the disease;
• glycated hemoglobin in the blood.

A blood test for type 2 diabetes is positive if:

• the level of glucose in capillary blood exceeds 6.1 mmol/l;
• when testing for tolerance, 2 hours after taking glucose, its level is more than 11.1 mmol/l; if the glucose level is in the range of 7.8-11.1 mmol/l, a diagnosis is made, which requires further examination under the supervision of a therapist;
• with a glycated hemoglobin content of 5.7%, a person is considered healthy, a concentration of more than 6.5% - the diagnosis is confirmed, intermediate values ​​- a high risk of development.

When are injections necessary?

In severe cases of the disease, insulin injections are prescribed along with medications. Thus, this form of the disease can become insulin dependent, making life much more difficult.

Depending on how capable the body is of compensating for carbohydrate metabolism disorders, There are three stages of the disease:

1. Reversible (compensatory).
2. Partially reversible (subcompensatory)
3. Carbohydrate metabolism is irreversibly impaired - the stage of decompensation.

Symptoms

There are many cases when the disease is detected by chance, during a routine examination, during a blood sugar test. More often, symptoms appear in overweight people and those who have crossed the 40-year mark.

Associated symptoms:

• frequent bacterial infections due to decreased immunity;
• limbs lose normal sensitivity;
• Poorly healing ulcers and erosive formations appear on the skin.

Treatment

Is there a cure for type 2 diabetes? Every sick patient asks this question.
Existing standards for the treatment of type 2 diabetes mellitus consider the main principle to be the achievement of the following goals:

• elimination of symptoms;
• decreased blood sugar levels;
• control of metabolism;
• warning ;
• ensuring the highest possible standard of living;

1. Diet;
2. Recommended physical activity;
3. Self-monitoring of the patient’s condition;
4. Teaching the patient skills to live with diabetes.

If diet therapy is ineffective, then additional drug therapy is prescribed.

Drug treatment of type 2 diabetes mellitus: drugs that lower sugar

Modern pharmacotherapy for diabetes mellitus 2 offers many different drugs that lower sugar. Medicines are prescribed based on laboratory parameters and the general condition of the patient. The severity of the disease and the presence of complications are taken into account.

Groups of medications prescribed to patients with type 2 diabetes to lower blood sugar (glucose) levels:

1.Sulfonylurea derivatives– have a double effect: they reduce cell resistance to insulin and increase its secretion.
In some cases, they can sharply reduce blood sugar levels.
Prescribed drugs: glimeperide, chlorpropamide and glibenclamide, etc.

2. Biagunids. Increases the sensitivity of muscle tissue, liver and fatty tissue to insulin.
They reduce weight, normalize lipid profile and blood viscosity.
The drug Metformin is prescribed, but it causes side effects, stomach and intestinal disorders, as well.

3. Thiazolidinone derivatives reduce glucose levels, increasing the sensitivity of cell receptors and normalize the lipid profile.
The medications prescribed are rosiglitazone and troglitazone.

4. Incretins improve the function of pancreatic beta cells and insulin secretion, inhibit the release of glucagon.
The drug prescribed is glucagon-like peptide-1.

5. Dipeptidyl peptidiase inhibitors 4 improve glucose-dependent insulin release by increasing the susceptibility of pancreatic beta cells to the entry of glucose into the blood.
The medications prescribed are vildagliptin and sitagliptin.

6. Alpha-glucosidase inhibitors disrupt the absorption of carbohydrates in the intestines, reduce the concentration of sugar and the need for injections.
Miglitol and acarbose are prescribed.

IMPORTANT!

Drugs that lower blood sugar levels are prescribed exclusively by the attending physician, since self-medication in this situation is life-threatening. The list of drugs is for informational purposes only.

Combination therapy involves prescribing 2 or more medications at the same time. This type has fewer side effects than taking one drug in a large dosage.

Modern methods of treating type 2 diabetes mellitus

Modern treatment of type 2 diabetes requires doctors to achieve the following goals:

• stimulate insulin production;
• reduce tissue immunity (resistance) to insulin;
• reduce the rate of synthesis of carbohydrate compounds and slow down the process of its absorption through the intestinal wall;
• correct the imbalance of lipid fractions in the bloodstream.

At first, only 1 drug is used. Subsequently, several are combined. If the disease progresses, the patient’s condition is poor and previous medications are ineffective, insulin therapy is prescribed.

Physiotherapy and ozone therapy

• increases the permeability of cell membranes, which increases the flow of carbohydrates into the tissues and eliminates the lack of energy, while reducing protein breakdown;
• activates glucose metabolism in red blood cells (erythrocytes), which increases the saturation of tissues with oxygen;
• strengthens the vascular wall;
• especially effective for coronary heart disease and atherosclerosis in elderly patients.

But there are also disadvantages to ozone therapy: it can suppress the patient’s immunity, which can provoke the development of chronic infections and pustular skin lesions.

The course of treatment is up to 14 procedures, involving intravenous administration of saline solution that has undergone ozonation. Enemas with an ozno-oxygen mixture are also used.

The following physiotherapy procedures are used for diabetes:

• electrophoresis;
• magnetic therapy;
• acupuncture;
• hydrotherapy;
• physical therapy.

How to treat type 2 diabetes with nutrition?

Treatment regimens for type 2 diabetes mellitus using diet are based on the following principles:

• exclusion of refined carbohydrates (jams, desserts and honey) from the diet;
• fat intake should correspond to 35% of the daily requirement;
• counting the number of bread units and bringing your diet in line with the doctor’s recommendations.

Many patients have some degree of obesity, and therefore, by achieving weight loss, it is possible to achieve a decrease in glycemia (glucose), which often eliminates the need for drug treatment diseases.

Diet therapy is the main part of treatment. The proportion of proteins in the diet should be 20%, fats -30% and carbohydrates 50%. It is recommended to divide meals into 5 or 6 times.

Fiber in the diet

A prerequisite for a therapeutic diet is the presence of fiber.
Rich in fiber:

Including guar, fiber and pectin in the diet gives excellent results. The recommended dosage is 15 grams per day.

What is a bread unit

The practical significance of the bread unit is that it can be used to determine the dose of injection for oral administration. The more bread units consumed, the larger the dose is administered to normalize glucose levels in the body.

For the error-free calculation of XE, many special tables have been compiled containing a list of food products allowed for patients with diabetes and the correspondence of the indicated units to them.

Folk remedies

Folk remedies can be considered as an addition to the main therapy.

A noticeable effect is observed a month after systematic use.

IMPORTANT!

Before you start using various herbal infusions the patient is advised to consult a doctor, since the use of some herbs has contraindications for various conditions.

Useful video

What treatment methods are considered the most effective? Watch the video:

Goals of therapy

The main goal of treating type 1 and type 2 diabetes mellitus is to preserve the patient’s quality of life and normalize metabolism. It is important to prevent the development of complications, to adapt a person to life taking into account this complex diagnosis. Proper treatment only delays the onset of serious consequences.